Risk score for peri-interventional complications of carotid artery stenting

Background and Purpose-Routinely available independent risk factors for the peri-interventional outcome of patients undergoing elective carotid artery stenting (CAS) are lacking. The rationale of the study was to create a risk score identifying high-risk patients. Methods-We prospectively enrolled 606 consecutive patients assigned to CAS at a secondary care hospital. Various biochemical. clinical, and lesion-related risk factors were prospectively defined. The primary end point reflecting periprocedural complications encompassed minor and major stroke, nonfatal myocardial infarction and all-cause mortality within 30 days. Results-Three percent of patients (n = 18) experienced a nonfatal minor (n = 13) or major (n = 5) stroke. 1.3% of patients (n = 8) died from fatal stroke (n = 4) or other causes (n = 4). No myocardial infarction was observed within 30 days after stenting. Multivariable analysis revealed diabetes mellitus with inadequate glycemic control (HbA(1c) > 7%), age >= 80 years, ulceration of the carotid artery stenosis, and a contralateral stenosis >= 50% as independent risk factors. A risk score formed with these variables showed a superior predictive value (C-statistic = 0.73) compared with single risk factors. The presence of 2 or more of these risk factors identified patients with a risk of 11% for a periprocedural complication compared with 2% in patients with a score of 0 or 1. Conclusions-In patients undergoing elective CAS, a risk score based on routinely accessible variables was able to identify patients at high-risk for atherothrombotic events and all-cause death within 30 days after the intervention.